The Ideal and the Real of Breast-Feeding
不必迷信母乳喂养

Concern is mounting that the "breast is best" dogma is creating undeserved guilt and serious hardships for a growing number of new mothers, many of whom work full time and cannot afford, professionally or financially, the prolonged maternity leaves needed to breast-feed their infants for the time now recommended.

越来越多人担心，“母乳最好”的训条会为越来越多的新妈妈带来不必要的负罪感与煎熬，很多新妈妈需要从事全职工作，工作与家庭财务的压力决定了她们无法获得较长的产假，因此不可能按如今推荐的母乳喂养时间来哺育宝宝。

Forty-three years ago, when my twin sons were born, the pressure to breast-feed exclusively for six months was not as strong as it is today. I nonetheless felt I had let them - and myself - down when this proved impossible. I had looked forward to feeding only breast milk for the six months of maternity leave my job allowed. But nature had a different plan.

43年前，在我的一对双胞胎儿子出生时，全母乳喂养（指只喂养婴儿母乳，不搭配配方奶和辅食等的喂养方式——译注）整整六个月的压力还不像现在这么大。可是在我发现无法达到这个要求时，还是感觉辜负了宝宝和我自己。我的工作允许休六个月的产假，所以我的本意是在他们出生的这六个月里进行全母乳喂养，但大自然另有安排。

At seven months pregnant, I learned I was carrying twins, and my doctor ordered me to stop working to avert an early delivery. The boys, born at 6 pounds 12 ounces each, were delivered by emergency Caesarean, after which I developed a life-threatening womb infection. Sustained by an IV drip for eight days, I was isolated from the babies and pumped breast milk while they suckled formula.

在怀孕七个月时，我得知自己怀的是双胞胎，医生要求我停止工作，避免早产。经过紧急剖腹产，我生下了两个宝宝，每个都重6磅12盎司（合3.06公斤），但在此之后我出现了危及生命的宫腔感染，输了八天液，没法实现母婴同室，在他们喝着配方奶时，我只能用吸奶器把母乳吸出来。

When we finally left the hospital, each boy was downing four ounces of formula every four hours, and I was producing less than half that in breast milk. My doctors gave contradictory advice.

出院时，两个男宝宝每四个小时要喂四盎司（合113克）配方奶，而我吸出的母乳还不到这个量的一半。我的医生们对此给出了截然相反的建议。

Obstetrician: Just nurse them and your milk will come in. If you give them bottles, they won't bother to nurse.

产科医生说：你只要坚持喂母乳，奶总归是够的。假如你老是喂他们配方奶，他们就不会费劲吸你的奶了。

Pediatrician: Forget about nursing. Give them formula, or they will be hungry and crying every two hours. They'll lose weight, and you and they will be miserable.

儿科医生说：别管母乳了。喂他们配方奶，否则他们会饿得每两个小时大哭一次。他们会变瘦的，这样宝宝跟你都会很不好受。

After a good cry myself, I decided to meld the advice: Nurse the babies first, and top off each feeding with formula. The boys gradually reduced their dependence on formula. But then I had to return to work, an hour's commute from home, to an office without on-site day care or any place to express milk.

我痛哭一场，决定中和两方建议：每次我先喂母乳，不够的时候再添奶粉。两个宝宝逐渐不再那么依赖配方奶了。但很快我就得重返职场，路上要花一个小时，而且办公室既没有日托所，也没有可以关起门来吸奶的地方。

An Insurmountable Gap

无法逾越的鸿沟
 
Many more women now work full time, most in places that cannot accommodate a nursing mother. Few can afford an extended unpaid maternity leave. As Alissa Quart noted recently in a lively essay in The New York Times, "The Milk Wars," many new mothers are finding it difficult, if not impossible, to feed their babies nothing but breast milk for six months.

现在做全职工作的女性越来越多，而且大部分工作场所都不利于妈妈哺乳。没有多少人能承受超期无薪产假带来的负担。艾丽萨·夸特(Alissa Quart)近来在《纽约时报》上发表了一篇非常生动的随笔，标题是《母乳战争》(The Milk Wars)，在文中她指出，大量新妈妈都发现在宝宝六个月前除了母乳，其他什么都不喂，这是件极困难的事情，甚至可以说是不可能完成的任务。

Health officials have likened the failure to breast-feed to the risk of smoking during pregnancy, adding to the distress and guilt suffered by these women.

而卫生部门的官员则把未能母乳喂养给婴儿带来的危害，与怀孕期间吸烟的危害相提并论，令这部分女性的苦恼与负罪感又加深了一层。

But as a recent study in Scotland showed, the gap between what is ideal and what is real is insurmountable for many families. The authors, who conducted 220 face-to-face interviews, mostly with pregnant women, new mothers and their partners, concluded that more realistic, achievable goals should be set, particularly in countries like the United States and Britain, which have struggled and thus far failed to meet targets for breast-feeding.

最近在苏格兰进行的一项研究显示，对于很多家庭来说，母乳喂养的理想与现实之间，存在着一条无法逾越的鸿沟。作者进行了220次面对面的访谈，大部分对象为孕妇、新妈妈以及她们的伴侣，结论是在需要设定一个更现实、更易于实验的母乳喂养目标，在像美国和英国这类国家尤其如此，这些国家的妇女虽然几经艰辛挣扎，仍然很难达到母乳喂养的目标。

Hanna Rosin, mother of three breast-fed babies, wrote in The Atlantic in 2009 that breast-feeding involves "a serious time commitment that pretty much guarantees that you will not work in any meaningful way. When people say that breast-feeding is 'free,' it's only free if a woman's time is worth nothing."

汉纳·罗辛(Hanna Rosin)母乳喂养了三个孩子，2009年她在《大西洋月刊》(The Atlantic)杂志撰文称，母乳喂养需要“牺牲大量时间，你几无可能以任何有意义的方式工作。人们说母乳喂养是‘免费’的，而事实上母乳免费的前提是，人们把母乳妈妈付出的时间看作分文不值。”

The Scottish researchers, whose study was published in March in the journal BMJ Open, concluded that there is "a clash between overt or covert infant feeding idealism and the reality experienced." Some families, they found, "perceive that the only solution that will restore family well-being is to stop breast-feeding or introduce solids."

苏格兰的这项研究报告发表在《英国医学杂志（网络版）》(BMJ Open)的三月号上，研究者的结论是“在公开或隐秘的婴儿喂哺的理想与现实之间，存在着冲突”。他们发现其中一些受访家庭“认为，只有停止母乳喂养，或者让婴儿开始吃固体食品，这才可能让全家人重拾幸福”。

Even mothers who planned to devote themselves to breast-feeding often struggled with the time it took away from getting back to their pre-pregnancy lives, including sleep, exercise, friendships, couple time, attention to other children, even housework.

即使是拿定主意想要母乳喂养的妈妈们，也往往会因为无法恢复孕前的正常生活而感到纠结，因为母乳喂养可能会占用各种时间，包括睡眠、健身、交友、与丈夫共处，照顾别的孩子，以及做家务的时间。

There may be little net benefit to breast-feeding if it results in distressed mothers or marital or family discord. As one woman in the Scottish study said, "It all seems to be, 'Don't ever do anything that would interfere with breast-feeding' ... But it just doesn't fit in with the rest of your life, and I think people just give up because it's too difficult."

如果坚持喂母乳可能会导致母亲郁郁寡欢，或者家庭不和，这么做或许就得不偿失了。苏格兰这项研究的一位被访者说，“看起来，‘你不能做任何对母乳喂养不利的事情’……但它真的跟你生活中的其他事情都格格不入，我觉得人们放弃母乳喂养，原因在于它真的是太辛苦了。”

In some cases of exclusive breast-feeding, the women's partners or other children felt left out of baby care and the bond that comes from feeding a new baby. Another woman in the study said of her partner, "I think he's really delighted that the baby will finally take a bottle from him; that's their time to sit and chill. I think he feels more connected as well, just being able to do that."

也有些时候，母乳妈妈的伴侣或其他孩子会感觉自己因此没法参与照顾家中的这个新生命，也无法体会到哺育小宝宝的幸福感。参与研究的另一位女性这样形容自己的伴侣，“宝宝终于能喝他递过来的奶瓶，我想他真的非常幸福；他们父子二人总算能坐在一起好好享受一下了。我觉得，光是参与喂奶，他就能感觉到与宝宝更加亲密。”

The authors concluded, "Six months exclusive breast-feeding is considered unrealistic and unachievable by many families, and promoting this is perceived as setting parents up to fail."

作者总结道，“在很多家庭看来，六个月全母乳喂养是不现实并且无法实现的，鼓吹这个目标，就等于是宣判家长不合格。”

They recommended that rather than dictate how babies are fed, health professionals should have open-ended discussions with families to see how well a particular feeding regimen would fit into family life.

该研究的作者建议，卫生部门的从业者不应武断决定婴儿的喂养方式，而应坐下来与人们探讨，从而判断出某种特定的喂养方式是否能适应现代的家庭生活。

Uncertain Evidence

不明确的证据

Some mothers in the Scottish study resented the "propaganda" promoting breast-feeding, calling the message that "breast is best" overdone and questioning the strength of evidence that exclusive breast-feeding for six months reduces a baby's risk of developing allergies, asthma, eczema, ear infections, obesity, diabetes, heart disease, sudden infant death and diminished intelligence, as well as protecting mothers from breast cancer.

参与苏格兰这项研究的一些母亲表示，她们很讨厌母乳喂养的“宣传攻势”，认为“母乳最好”言过其实，表示全母乳六个月带来的种种裨益证据不足，此前人们称，这样喂养可以减少婴儿患过敏、哮喘、湿疹、耳道感染、超重、糖尿病、心脏病、婴儿猝死和智力下降的危险，并能减少母亲罹患乳腺癌的机率。

Although there is some evidence supporting such claims, no randomized, controlled trials - the gold standard of scientific research - have proved that breast-fed babies fare better, at least in industrialized countries.

尽管有一些证据证明上述主张，但目前还没有随机对照实验——而这是科学实验的金科玉律——能够证明，母乳喂养的婴儿确实生存率更高，至少在工业化国家这一点并不准确。

Babies who are exclusively breast-fed for six months typically come from families that differ in a variety of ways from those weaned early or fed formula from the outset. (Of course, breast-fed babies do fare better in less developed areas, where formula may be prepared with contaminated water or poverty prompts mothers to skimp on its use.)

通常来说，给婴儿进行了六个月全母乳喂养的家庭，在诸多方面与早早断奶或者一开始就喂配方奶的家庭存在各种不同。（在欠发达地区，母乳喂养的宝宝生存率确实更高，这可能是因为冲调配方奶的水不干净，或者是因为迫于经济压力，母亲没有给宝宝喂足量奶粉。）

As for the antibodies that protect babies early in life, most are acquired not through breast-feeding but via the placenta during pregnancy. The main exceptions are antibodies against gastrointestinal infections (vomiting and diarrhea); these antibodies are transferred to a baby's gut through breast milk but not formula.

至于保护小婴儿的抗体，大部分并不是通过母乳，而是经由胎盘获取的。其中一个最主要的例外是一种能避免婴儿发生胃肠道感染（呕吐和腹泻）的抗体，这种抗体只能通过母乳传递给婴儿，配方奶里没有。

Based on her review of the medical evidence, Ms. Rosin, in her Atlantic article, wrote, "It shows that breast-feeding is probably, maybe, a little better, but it is far from the stampede of evidence" that has been promoted in the popular literature.

罗辛在回顾了各种医疗证据后，在《大西洋月刊》的这篇文章中写道：“数据表明母乳喂养可能、或许是稍好一点点的喂养方式，但是并不存在充分证据”，证明它拥有大众媒体所宣扬的种种好处。

"Over all," she concluded, "breast is probably best, but not so much better that formula deserves the label of 'public health menace,' alongside smoking."

她总结道：“总的来说，母乳也许是最好的，但它的好处还不足以让配方奶沦落到跟吸烟一样的境地，被人打上‘公共卫生公敌’的标签。”

Perhaps it is time for more realistic, less polarizing messages about breast-feeding.

或许，是时候在母乳喂养这件事情上，传递出更理性、不偏激的信息了。

来源：好英语网